Does Health Insurance Cover Medical Cannabis?

First the good news: most private health insurers cover some or all of the costs of medical cannabis prescriptions. However, some of the largest health insurers in Australia still don’t offer coverage for medical cannabis, so you need to make sure your insurer offers coverage before making a claim. At present, medical cannabis products are generally not covered by Medicare or the Pharmaceutical Benefits Scheme (PBS).

What Companies Subsidise Medical Cannabis in Australia?

These days, the majority of health insurance companies in Australia provide some coverage for medical cannabis. The exact coverage will depend on your specific plan. Below we compare some of Australia’s largest insurers and the best options for securing medical cannabis coverage.

This isn’t an exhaustive list — many other health insurers also include medical cannabis in their coverage. Ask your provider whether you’re covered, or look around for plans that will cover you.

Medibank

Medibank offers coverage for medical cannabis under their range of Extras plans. The most affordable of these plans (Healthy Start Extras) covers up to $500, but that’s a combined limit with other Extras services like physiotherapy and mental health support. A maximum of $21 can be claimed per script. Medibank also lets you claim for ancillary medical cannabis products, such as TGA-approved vaporisers.

If you opt for a more comprehensive plan, you could claim up to $600 per year for non-PBS pharmaceuticals (including medical cannabis).

Health Insurance Fund of Australia (HIF)

HIF was the first insurance company to offer coverage for medical cannabis back in 2020. All of their Extras plans (except Basic) cover the cost of non-PBS pharmaceuticals.

On their Savers plan, HIF will pay $80 per script for medical cannabis, up to a total of $350 per year across a range of Extras services. The Essential Extras Plan covers up to $200 just for non-PBS pharmaceuticals.

Onemedifund

Onemedifund will cover up to $65 per script (after the maximum PBS amount has been deducted). Their Comprehensive Extras Plan covers up to $500 per year for non-PBS pharmaceuticals (or $1000 per family).

nib Health Insurance & HBF

nib Health Insurance and HBF technically offer up to $65 per script for medical cannabis under non-PBS pharmaceuticals. However, at this time, only medical cannabis products listed on the ARTG are covered. This means that the majority of medical cannabis users won’t get coverage. The only currently ARTG-approved product that isn't on the PBS is Sativex for multiple sclerosis.

Sector-Specific Health Care Plans

If you work in specific sectors, your health coverage will likely include medical cannabis. For example, the Defence Fund will cover up to $900 annually. Navy Health ($200), Police Health ($600) and Transport Health ($300) also provide coverage. Teachers’ Health, on the other hand, only covers ARTG-listed pharmaceuticals and Nurse's Health doesn't cover medical cannabis at all.

Bupa & HCF

Despite being two of the largest health insurers in Australia, neither Bupa or HCF offer coverage for medical cannabis.

This is an area that is changing very quickly in Australia. We strongly encourage you to check your policy details or speak with your insurance provider to confirm your coverage.

Medicare & Pharmaceutical Benefits Scheme

At present, medical cannabis products are generally not covered by Medicare or the Pharmaceutical Benefits Scheme (PBS). In order to be covered by the PBS a medication has to be fully registered with the TGA and then also approved by the Pharmaceutical Benefits Advisory Committee. As of writing, the only medication that has passed both thresholds is Epidyolex, a CBD oil prescribed to children with rare forms of epilepsy.

Medicare is also unlikely to cover the cost of medical cannabis consultations, because most telehealth cannabis services do not bulk bill. However, an appointment with your local GP may well be bulk billed or offer a partial Medicare rebate, even if it's about a potential medical cannabis prescription.

What Does Health Insurance Cover?

Most insurance providers will have coverage for non-PBS pharmaceuticals under their General Treatment or Extras plan, which usually includes medical cannabis. (The exception is insurers that only cover ARTG-approved medicines, which excludes all medical cannabis except for Epidyolex prescribed for childhood epilepsy.)

Private health insurance covers prescriptions for medical cannabis from an Authorised Prescriber (AKA medical marijuana doctor) or through the Special Access Scheme. These prescriptions are for branded cannabis products, which can include oils, flower, capsules, sprays and more. If you are prescribed a compounded product, you may not be able to claim this through your insurer.

Through a consultation, your doctor will help determine the right product, cannabinoid profile and dose for your needs. The cost of medical cannabis will vary depending on your individual treatment plan and this could affect how much your health insurance will cover.

Every private health insurance policy offers slightly different coverage for medical cannabis. Typically, a provider will cover up to a predetermined maximum cost each year. They will normally also have a limit on the cost per script. You will still be responsible for paying the maximum PBS amount, which is $30 in 2023.

You should also note that most companies have fairly low annual limits for the amount you can claim, so you may not be covered for a full 12-month period if you have an ongoing medical cannabis prescription.

What Do I Need to Know When Talking To My Health Insurer?

Making a claim in Australia for medical cannabis is usually reasonably straightforward (given they provide coverage).

Typically, the process for making a claim is:

• Pay for your medication.
• Ask for a receipt that includes the medication details, cost details and prescriber information.
• Submit your claim through your insurer’s app or website.

Some providers will also want evidence of your TGA approval, which your prescriber can provide. Occasionally, providers will ask you or your doctor to complete additional forms before purchasing the medication. We have even seen some insurers ask for a dispensing history from your pharmacy, but that is rare.

Mostly, it’s vital that you know what your insurer needs before you purchase your medication, so you don’t get any nasty surprises. So review your policy and, when in doubt, call the insurer and ask.